Abortion Paperwork Florida Form PDF Details

If you are considering an abortion in Florida, you will need to complete some paperwork. This document outlines the steps you need to take and provides some useful information about the process. Abortion is a personal choice, and we hope this form will help make the process easier for you. Thank you for choosing to read our blog.

QuestionAnswer
Form NameAbortion Paperwork Florida Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesreal abortion discharge papers, abortion papers, get the real abortion discharge papers florida form, florida paperwork to file show cause order form

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STATE OF FLORIDA

ABORTION

CERTIFICATION FORM

SECTION I

1.Recipient’s Name:_____________________________________________________

2.Address:_____________________________________________________________

3.Medicaid Identification Number:__________________________________________

SECTION II

4.On the basis of my professional judgment, I have performed an abortion on the above named recipient for the following reason:

The woman suffers from a physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused or arising from the pregnancy itself that would place the woman in danger of death unless an abortion is performed.

Based on all the information available to me, I concluded that this pregnancy was the result of an act of rape.

Based on all the information available to me, I concluded that this pregnancy was the result of an act of incest.

I have documented in the patient’s medical record the reason for performing the abortion; and I understand that Medicaid reimbursement to me for this abortion is subject to recoupment if medical record documentation does not reflect the reason for the abortion as checked above.

5. ________________________________

6. ___________________________

Physician’s Name

Physician’s Signature

7.________________________________ 8. ___________________________

Physician’s Medicaid Provider Number

Date of Signature

August 2001

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1. You will need to complete the abortion paperwork florida accurately, therefore be careful while working with the areas including all these blank fields:

Writing section 1 of fl abortion form

2. After performing the previous step, go on to the next stage and complete the essential details in all these blank fields - record documentation does not, Physicians Name, Physicians Signature, Physicians Provider Number, Date of Signature, and AHCA MedServ Form JUN .

Date of Signature, AHCA MedServ Form  JUN , and record documentation does not of fl abortion form

Concerning Date of Signature and AHCA MedServ Form JUN , ensure you do everything correctly in this section. Both these are definitely the most important fields in this page.

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